HomeMy WebLinkAboutMortgage_Simpson� STATEMENT OFMORTGAGE OR CONTRACTINDEBTEDNESS
= FOR DEDUCTION FROM ASSESSED VALUATION Coun T!Iownship�. Year
�'. w� ♦ State Fwm 43709 (RS / 4-03) i7� �
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`��, Presaibe0 by DepaM1ment a( Local Govemment Fina�we jj �,{�
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NOV 0 3 1UO3
�TRUCTIONS: File,Mark
6e filed in person or by mail with the County Auditor of the county where the property is located.^ � i� n�
Filing Dates: 1) Real Property: During the 12 months before May 11 of the year the deduction is to be efrective.
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2) Mobiie Homes assessed under IC 6-1.1-7: Between January 15 and March 2 of the �e�r.the deducNon is;tobe'effective.
See reverse side for additional instructions and qualifications.
Applicant
buye�-see
C—J
Taxing District
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Assessed value of real property as of
March 1, curtent year
no, what is his / her exact share of interest?
reverse
Key number / legal description / I Record number
3-
Page number
o��-c��Y��- o�
Mortgage / Contract indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year owner? �'Yes ❑ No
� / .� �.5 y
If owned with someone other tnan spouse, indicate with whom.
name on record is different than that of appticant, indicate below:
of mortgagee or contract seller
5/ 3
of mortgagee or contracl seller (number and street, city, state. ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and street, ciry, state. Z/P code)
Dces appficant own property in any other If yes, what county? What Tax
counry in Indiana?
COUNTY AUDITOR
the amount
r"�Jl'�F�i /L'' � • , �
County Auditor
❑ Mobile Home (IC 61.1-7)
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Date
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;on
7No
certify under the penalry ot perjury that the above and foregoing infortnation is true and cortect and that the applicants was / were
'��ent of Indiana and owner of the aforementioned property on Maroh 1, 20
(owners lull name)
Person aulhorized by duly executed Power of Attomey
or by IC G1.1-12-.07
person